<div class="form400">
	<form action="<?= $payment_method_obj->get_form_action($payment_method, $order, true) ?>" method="post">
		<?= flash() ?>
		
		<div class="form">
			<ul class="formElements">
				<li class="field text left">
					<label for="CNAME">Cardholder Name <span class="required">*</span></label>
					<div class="fieldContainer">
						<input autocomplete="off" name="transaction[credit_card][cardholder_name]" value="<?= $payment_method_obj->get_field_value('transaction[credit_card][cardholder_name]') ?>" id="CNAME" type="text" class="text"/>
					</div>

					<div class="clear"></div>
				</li>

				<li class="field text right">
					<label for="ACCT">Credit Card Number <span class="required">*</span></label>
					<div class="fieldContainer">
						<input autocomplete="off" name="transaction[credit_card][number]" value="<?= $payment_method_obj->get_field_value('transaction[credit_card][number]') ?>" id="ACCT" type="text" class="text"/>
					</div>

					<div class="clear"></div>
				</li>

				<li class="field text left">
					<label for="EXPDATE">Expiration Date (MM/YY)</label>
					<div class="fieldContainer">
						<input autocomplete="off" name="transaction[credit_card][expiration_date]" value="<?= $payment_method_obj->get_field_value('transaction[credit_card][expiration_date]') ?>" id="EXPDATE" type="text" class="text"/>
					</div>

					<div class="clear"></div>
				</li>
				
				<li class="field text right">
					<label for="CVV">Card Verification Value (CVV)</label>
					<div class="fieldContainer">
						<input autocomplete="off" name="transaction[credit_card][cvv]" value="<?= $payment_method_obj->get_field_value('transaction[credit_card][cvv]') ?>" id="CVV" type="text" class="text"/>
					</div>

					<div class="clear"></div>
				</li>

			</ul>
			<div class="clear"></div>
		</div>
		
		<?
			$hidden_fields = $payment_method_obj->get_hidden_fields($payment_method, $order);
			foreach ($hidden_fields as $name=>$value):
		?>
			<input type="hidden" name="<?= $name ?>" value="<?= h($value) ?>"/>
		<? endforeach ?>

		<?= backend_button('Submit', array('href'=>"#", 'onclick'=>"$(this).getForm().submit(); return false;")) ?>
	</form>
</div>
